1. 1 Obesity among school children in Thailand: inquiry on demand for and supply of fast food and healthy food and policy interventions. Sirinya Phulkerd 15 June 2007

2. 2 Outline Background Study Aim Objectives Methods

3. 3 Background Overweight and Obesity Problem in Thailand Facing of under-and over-nutrition, along with a rise in overweight and obesity among adults (Kanchanachitra et al., 2003). Ranked the third disease burden due to risk factor for female with 6.1% of total DALYs loss and 2.5% for male (the 2004 BOD study). Increasing BMI in all age groups between 1986, 1995 and 2003 (the 2003 National Nutrition Survey), with the greatest increase in 30-39 years of age. An increasing trend of obesity in Thailand, specifically among affluent urban populations (the 1985 Electricity Generating Authority of Thailand, Adults with Dental Diseases study in 1989-1990, the 1991 study by Ramathibodi Hospital staff). An annual increase of 1.1% and 1.86% in the prevalence rate of overweight and obesity among Thai men and women age 20 years between 1991 and 1996 (Popkin, 2006). Note: overweight (25BMI30) and obesity (BMI30)

4. 4 Background (contd) Overweight and Obesity Problem in Thailand BOD attributable to physical inactivity, contributed to 1.0% among male and 1.8% among female (the 2004 BOD study). The physical activity among Thai children with obesity and non- obesity, reported lower than that recommended by WHO 2001. Increasing the energy derived from dietary fat from 8.9% in 1960 to 22.2% in 1995 (Kosulwat V, 2002). Increasing household consumption expenditure on oil and fat by 56% in nominal term between 1998 and 2005 (NESDB, 2004).

5. 5 Fast Food What is Fast Food? Food with high in fat, salt, and sugar, such as hamburgers, pizza, chicken, and sugar-loaded soft drinks, often called an unhealthy diet (WHO, 2005). Fast food causes overweight and obesity, doesnt it? Fast food consumption are a probable causal factor in weight gain and obesity (WHO/FAO 2002). Fast food is one of the contributing factors to obesity epidemic especially among childhood (Hu FB et al., 2001; Slavin JL et al., 1999).

6. 6 in Thailand Fast Food in Thailand Fast food rapidly expanded in Southeast Asia including Thailand in the 1990s and has become socially acceptable at affordable price for Thai people (Euromonitor, 2000). The growth of fast food franchises has influenced consumption and behavioral pattern of Thai people (Uusitalo U et al., 2002). The U.S. fast-food restaurants in Thailand had grown at an estimated 30-40 percent a year between 1999 and 2004 (Peter K, 2004). Pizza Co grew by 29%, from 1,468 million bahts in 2003 to 1,893 million bahts in 2005. (Minor International Public Co Ltd. Annual report, 2005). A strategy to boost demand with mobile delivery by Pizza Hut resulted in 40% increases in customers (Euromonitor, 2000; Businessday, 2001; Bangkok Post, 2001). Ranked the ninth most commonly consumed light meals among Thai children aged 6-14 years (the 2003 NNS). Among adult aged 15-59, 26.9% consumed fast food, comparing to 10.8% consumed brown rice and 3.5% for dietary supplement (the 2003 NNS).

7. 7 in Thailand Fast Food in Thailand (contd) Interventions No interventions for overweight and obesity prevention in relation to fast food industry in Thailand. Only several health promotion programs notably school-based weight control program (though the coverage is still low) and Healthy Thailand, launched through the Ministry of Public Health recently. Food labeling on nutritional fact and RDA, launched by FDA but not cover fast food products.

8. 8 Functional Food What is Functional Food? There is no internationally agreed definition of functional food, and most countries have no legal definition (WHO, 2004). In Japan : Foods which are expected to have a specified effect on health due to the relevant constituents, or food from which allergens have been removed. In Europe, the FUFOSE (Functional Food Science in Europe): Satisfactorily demonstrated to beneficially affect one or more target functions in the body, beyond adequate nutritional effects, in a way which is relevant to either an improved state of health and wellbeing.

9. 9 in Thailand Functional Food in Thailand Nutraceutical and Functional Food Research and Development Center, PSU: Functional food is a food product that contains high quantity of natural active ingredient, which has the ability to protect or relieve the consumer from certain disease or ailment, or improve their health or well being through its nutritional or medicinal properties. FDA-ongoing work: 1.adoption of health claims 2.developing dietary supplement and functional food regulations 3.developing guidelines for review of dietary supplements and functional foods 4.developing standard label claims. Functional foods are not dealt with specifically by the food or drug legislation (FDA Thailand 2004).

10. 10 in Thailand Functional Food in Thailand (contd) Interventions Few interventions on healthy food products such as Promotions in nutraceutical and functional food products, focusing on natural plant based ingredients such as Brown rice, Som Khaek (Garcinia cambogia), Makham Pom (Phyllanthus embrica). Service offered by private sectors such as Weight Control Program by MEDISCI Slim up Drain with Detox Program by Slim up Center Among adult aged 15-59, 3.5% consumed dietary supplement, while comparing to 26.9% fast food consumption and 10.8% for brown rice (the 2003 NNS).

11. 11 Study Aim To better understand the demand for and supply of fast food and healthy food among school children, as well as document and assess the effectiveness of current policy interventions in order to recommend appropriate policy to curb overweight problems in Thailand.

12. 12 Objectives 1. To compare the profile and determinants of demand for fast food and healthy food between primary and secondary school children who are overweight and not overweight, including their parents. 2. To describe the pattern of market strategies for fast food and healthy food for general population and in particular among primary and secondary school children and their parents. 3. To assess the current policy interventions and recommend the future policies on supply and demand sides to curb overweight and obesity problems and promote healthy food and other goods and services.

13. 13 Method (1) For Obj.1: To compare the profile and determinants of demand for fast food and healthy food between primary and secondary school children who are overweight and not overweight, including their parents. (Result = demand side characteristics) Conducting Survey Conducting Focus Group

14. 14 Conduct Survey Sample: overweight/non-overweight children in primary and secondary school and their parents Site: urban and rural areas of large cities in four regions (such as Khon Kaen, Songkla, Chiang Mai, Suphanburi, BKK) Instrument design: questionnaires assessing demographic and socio-economic status psychosocial and behavioral factors family, friends, schools commercial sites consumerism areas of Thailand in which the person lives media perception and knowledge of current interventions, aimed at - the reduction of overweight - healthy behavior promotion on food and exercise

15. 15 Focus Group Design: To discuss with the agents for change in primary and secondary schools in the survey sites e.g. teacher, principal, administrator, Teacher and Parents Association) What for? 1.to explore their awareness, factors associated with diet and physical activities at school and home. 2.to obtain information related to implementation of school policies for (a) wellness, (b) nutrition, (c) fitness, and (d) health among primary and secondary school children.

16. 16 Methods (2) For Obj.2: To describe the pattern of market strategies for fast food and healthy food for general population and in particular among primary and secondary school children and their parents. (Result = Supply side characteristics) Literature Review

17. 17 Literature Review What for? To compare the growth of fast food and healthy food industries including marketing expenditure and strategies i.e. Market research Distribution Pricing Packaging Product development Advertising Sales promotions Public relations Sources: based on information available from different national Sources Note: Pattern of current marketing to school children (TV advertising, in-school marketing, sponsorship, product placement, internet marketing and sales Promotions) investigated in the study sites.

18. 18 Methods (3) For Obj.3: To assess the current policy interventions and recommend the future policies on supply and demand sides to curb overweight and obesity problems and promote healthy food and other goods and services. (Result = The effectiveness of current policy interventions) Literature Review In-Depth Interviews

19. 19 Literature Review What for? 1.To review international experiences of related policy interventions. fast food and healthy foodphysical activities 2.To assess the availability and effectiveness of the current policy interventions (either by public, private and civil society) in Thailand for general population and school children, on overweight and obesity reduction, on fast food and healthy food, and physical activities in terms of Program output Outcome Target groups Program expenditure

20. 20 In-Depth Interviews What for? fast food and healthy foodphysical activities To deeply explore the respondents point of view, feelings and perspectives about the availability and effectiveness of the current policy interventions (either by public, private and civil society) in Thailand for general population and school children, on overweight and obesity reduction, on fast food and healthy food, and physical activities in terms of Program output Outcome Target groups Program expenditure Respondent: Key policy-stakeholders

21. 21 Focus group discussions What for? To recommend appropriate policies in preventing/reducing overweight & obese school children in Thailand (based on the results in method 1, 2, and 3). Group: concerned stakeholders, including consumer group education group professional group public health group financial group regulators and legislators industrial and business non-government organizations

22. 22 Snack Time Add subtitle here Thank You Snack Time